3D and 4D Ultrasound-Guided Peripheral Nerve Blocks: A Systematic Review
DOI:
https://doi.org/10.25751/rspa.27069Keywords:
3D ultrasound imaging, 4D ultrasound imaging, 3D or 4D ultrasound-guided, local anesthetic, peripheral nerve blockAbstract
IntroductionThe employment of the 3D and real-time 3D (widely known as 4D) ultrasound (US) as imaging technique for performing peripheral nerve blocks (PNB) has some advantages compared to the classical 2D ultrasound imaging. The aim of this review is to synthesize the current existing literature data concerning the feasibility of employing 3D and 4D ultrasound in performing PNBs, as opposed to the classical 2D US.
Material and MethodsThis paper is a systematic review of the existing English language literature on this topic in 2 database libraries: PubMed and Embase up to March 2020, undertaken to establish the opportunity of employing these imaging techniques in performing peripheral nerve blocks compared to the standard 2D ultrasonography. Inclusion criteria for the studies encompassed in the review were the following: patients and healthy volunteers who consented to undergo a PNB; intervention studied was any type 3D or 4D ultrasound-guided PNB; conditions of interest were those who required the employment of a PNB in their treatment; comparison was made with the standard 2D ultrasound-guided PNB technique; outcomes of interest were diverse: success rate of the blockage, circumferential spread of the local anesthetic around the nerve desired to be blocked, rate of failure, rate of complications. Exclusion criteria were the employment of the 3D and 4D ultrasound for other procedures than PNBs, interventions for which PNBs were performed but without the aid of 3D or 4D US imaging, studies in other languages than English.
Results11 studies encompassing a total of 94 subjects (patients and healthy volunteers) were included in a qualitative synthesis, the majority of them being case reports and case series (8 out of 11). The studies described different types of PNBs and in each study the advantages and drawbacks of 3D or 4D US employment identified by authors were noted. Overall, the number of identified advantages is higher than the number of identified drawbacks (20 vs 11). Moreover, major complications were not reported in any of the 11 studies.
Discussion and ConclusionsA positive balance between the advantages and the drawbacks of 3D and 4D US imaging methods in PNBs compared to the classical 2D US was identified, therefore employment of these imaging techniques in the field of regional anesthesia might represent a promising option. However, due to the weak strength of evidence of the studies included, further research is warranted.
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